LDL-cholesterol: the lower, the better

Disorders of fat metabolism is a major risk factor for a heart attack, stroke, or Vascular occlusion. A new European Lipid guideline for high-risk patients recommends even lower target values for LDL-cholesterol than in the past.

Already three years after the last update, the guideline was revised by the European cardiology society (ESC) and the European atherosclerosis society (EAS) and in the journal "European Heart Journal" published. It provides the LDL cholesterol as low as possible, especially in patients with high or very high risk for cardiovascular disease.

"The evidence is now overwhelming that a high LDL-Cholesterol level is a strong cause for heart attacks and strokes ist", Professor Colin Baigent, Chairman of the guideline, the responsible working group says. The experts therefore recommend a more aggressive approach with even lower target values according to the Motto: the lower, the better. Also, the output value does not matter. All high-risk patients benefit if their LDL levels are reduced in the blood more.

The guideline distinguishes between diseases, between four risk groups: persons with very high, high, moderate or low risk for cardiovascular:

  • For high-risk patients with a Ten-year risk of cardiovascular death over 10 percent, LDL target is below 1.4 mmol/l (<55 mg/dl) and a reduction in the LDL level of at least 50 percent compared to baseline. It comes in these patients, despite maximal lipid therapy depression to a second cardiovascular event, shall (to the LDL value of less than 1.0 mmol/l <40 mg/dl) be reduced.
  • For patients with high-risk (Ten-year risk for a cardiovascular-related death, 5 to 10 percent) of the guideline of an LDL target of 1.8 mmol/l (<70 mg/dl) and a LDL reduction of at least 50 percent compared to the initial value before.
  • For individuals with an intermediate risk (Ten-year risk 1 to 5 per cent) applies to a LDL target of below 2.6 mmol/l (<100 mg/dl) and for persons with low-risk (Ten-year risk < 1%) a LDL target of below 3.0 mmol/l (<116 mg/dl).

Statins: good verträpossible and effective

Also new to the guideline is the increased use of high-dose statins as well as ezetimibe and PCSK9-inhibitors is intended for use, in order to achieve the newly defined target values. While statins are still considered as the gold standard. "Statins are well tolerated and a true Statin intolerance is very selten", breaks Professor Dr. Francois Mach of a lance for this drug group. Overall, the Benefits outweighed a clear risk, so do. The same is true for the use in patients over 75 years of age, even if in this age group, the efficacy is somewhat weaker, as it says in the guideline.

Overall, the treatment stage, therapy is initiated. The Basis of a change in life-style and dietary measures. Second, statins are. The patient should first be given to the maximum tolerated dose. The goal is not to be achieved so that the values recommended by the guideline, the additional administration of Ezetiminib. Also, this is not sufficient, can be added in patients with very high and high risk of a PCSK9 inhibitors Alirocumab and Evolocumab.